Clinical-Surgical CorrelationBraz J Cardiovasc Surg 2005; 20(1): 94-95 CLINICAL DATA A 7-month-old female Caucasian infant weighing 5.3 kg, born at full term was referred to our department. At 2 months of age heart sounds were heard to the right of the chest and there was suspicion of dextrocardia. She was referred to a cardiologist for further investigations. At this time a congenital heart disease was diagnosed which was initially treated with digital and diuretics. The infant evolved with pneumonia and required hospitalization for a period of 30 days. She was in a good general state, ruddy, hydrated, acyanotic and with slight tachypnea. Her thorax was symmetrical; ictus cordis and fremitis were palpable at the 5 th intercostal space on the hemiclavicular line. The heart rhythm was regular with two clicks with the second sound hyperphonetic and a systolic murmur of regurgitation of 4+/6 at the lower right sternal border. Pulmonary auscultation was symmetrical without adventitious sounds. The liver was palpable 3 cm from the left costal margin. The extremities had palpable and symmetrical pulses without pressure differences between the limbs. ELECTROCARDIOGRAMThe electrocardiogram suggested dextrocardia with a negative P wave at the DI deviation on a horizontal plane. The rhythm was sinusal with a heart rate of 136 beats per minute, SAP + 60º, electrical axis of the QRS complex in the 1 st quadrant (SAQRS + 60º), PR 0.16, QR 0.04, QT 0.24 (QTc 0.36). Biventricular overload (Figure 1).
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